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Impact of Emergency Medicine Point-of-Care Ultrasound on Radiology Ultrasound Volumes in a Single Pediatric Emergency Department

  • Summer L. Kaplan
    Correspondence
    Corresponding author and reprints: Summer L. Kaplan, MD, MS, Department of Radiology, The Children’s Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA 19104.
    Affiliations
    Director of Emergency Radiology, Department of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania

    Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Aaron E. Chen
    Affiliations
    Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

    Director of Emergency Point-of-Care Ultrasound, Division of Emergency Medicine, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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  • Rachel G. Rempell
    Affiliations
    Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

    Director of Emergency Ultrasound Fellowship, Associate Medical Director for Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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  • Nafis Brown
    Affiliations
    Center for Healthcare Quality and Analytics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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  • Maria C. Velez-Florez
    Affiliations
    Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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  • Asef Khwaja
    Affiliations
    Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

    Director of Off-Site Imaging, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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      Abstract

      Purpose

      Point-of-care ultrasound (POCUS) is growing, but few data exist regarding its effects on radiology ultrasound (Rad US) volumes. The authors studied changes in Rad US ordered by emergency medicine (EM) as POCUS began and grew at their pediatric hospital.

      Methods

      This retrospective study included EM POCUS and EM-ordered Rad US volumes between 2011 and 2017, during three 2-year intervals: before POCUS, early POCUS, and expanded POCUS. Changes in overall Rad US and POCUS volumes per visit during these intervals were studied. Changes in skin and soft tissue infection (SSTI) US per SSTI visit, an examination performed diagnostically by both radiology and EM, were also assessed. Volume differences were examined using the Mann-Whitney U test (significance threshold, P < .05), and process control charts were used to identify nonrandom variations.

      Results

      The study included 49,908 Rad US and 2,772 POCUS examinations during 647,890 emergency department visits. Rad US volumes per visit remained unchanged during early POCUS (P = .858) but increased with expanded POCUS (P < .005). A transient nonrandom increase in Rad US occurred as POCUS began. SSTI Rad US per SSTI visit significantly increased (P < .001) during early POCUS but did not change with expanded POCUS (P = .143). An SSTI management pathway in the emergency department before expanded POCUS may have affected ordering. Other variation occurred in proximity to practice changes and seasonal patterns.

      Conclusions

      Rad US overall and specifically for SSTI increased or remained stable during the introduction and growth of EM POCUS. Rather than decreasing Rad US, EM POCUS had a complementary role.

      Key Words

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